Research on Quality Components for Service Design of Health Screening : Focus on IT Services
Ju Youn Chung*․Dukyoo Jung**
Abstract
This research proposes how to enhance low customer satisfaction with health screening services caused by procedural complexity and limits of health screening. The purpose of this study is to identify sub-components of the service quality provided by general health examination centers.
This is a qualitative analysis of in-depth interviews of providers and consumers of medical services.
The data were primarily analyzed by affinity diagram, and the data were sorted and analyzed according to the criteria suggested by Donabedian’s four components.
Four types of quality factors and the health screening service quality components of 39 subordinate items were assessed.
Components related to the use of IT facilities comprise a significant amount of the physical factors, and there are high demands for IT facilities among customers.
Keywords：Health Screening, Quality Management, Service Design
1)
Received：2020. 07. 30. Final Acceptance：2020. 08. 16.
** Adjunct Professor, Chief Research Officer, College of Software and Convergence Technology, Comics & Animation Technology major, Sejong University, e-mail：[email protected]
** Corresponding Author, Professor, College of Nursing, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, Korea, Tel：+82-2-3277-6693, e-mail：[email protected]
1. Introduction
As the service industry develops, the impor- tance of service is accentuated while changes in industrial structure are gradually expan- ding the field of design. Among other medical services, greater attention is being given to preventive health screening services. This has led to quantitative expansion of these services, especially in large medical institu- tions, as health screening is directly connected to financial efficiency in the private health screening sector. With numerous examina- tions and long wait times, health screening services have become increasingly complex and time-consuming, which requires improve- ment [Kim, 2014].
The quality of medical service includes the degree of satisfaction perceived by customers about the medical service they received; ser- vice users feel satisfied with service quality when the service satisfies or exceeds their expectations [Rosenstock, 2005]. The defini- tion of medical service quality varies depen- ding on the researcher, but most agree that it indicates an attitude related to the expec- tation, perception, and satisfaction of the ser- vice experienced during the interaction bet- ween providers and users of medical services [Milutinović et al., 2009]. In the preceding studies, factors influencing satisfaction about medical service quality were divided into tech- nological, human service, physical, and pro- cedural [Chang, 2007]. Factors influencing satisfaction can also be divided into physical environment factors and human service fac- tors. The former is subdivided into accessi- bility, cleanliness, attractiveness, and con- venience while the latter is subdivided into expertise, reliability, and responsiveness [Kim, 2010]. Another study analyzed the quality of medical service as constructs of procedure
use, human service, and service scape [Kang, 2014]. A previous study [Jin, 2015] investi- gated the influence of satisfaction with ser- vice quality on the behavioral intentions of customers by dividing medical services into factors of interaction, relationship quality, hospital atmosphere, tangibility, operational quality, support quality, and outcome quality.
Unlike general medical service, comprehen- sive health screening service does not include treatment. Comprehensive health screening service is centered around the physical envi- ronment of the examination, human service of medical professionals, procedural service of the examination, and support of the medi- cal organization [Kim et al., 2013]. Within this context, research has classified the com- ponents of comprehensive health screening service quality into physical, human, proce- dural, and supportive factors. Each factor is defined as follows based on preceding studies including Donabedian’s [Donabedian, 1980, 1983, 1987, 1990] definition. Physical factors are defined as tangible service factors inclu- ding the space and facilities provided by the health examination center [Chang, 2005, 2007;
Shelton, 2000]. The human factor is defined
as respectful attitude, competence, and consi-
deration of service providers in the health
examination center, including doctors, nurses,
medical engineers, and administrative staff
[Chang, 2007; Kim, 2010; Kang, 2014]. A pro-
cedural factor designates accurate transla-
tion of customer expectations into appropriate
health examination services as promised. It
includes administrative processes such as
reservation, reception, and waiting, as well as
the examination process [Chang, 2007; Kang,
2014; Moon et al., 2000]. A support factor is
defined as spontaneity and preparedness of
the medical organization providing health
examination services [Jin, 2015].
This research aims to propose enhance- ments for customer satisfaction with services that are currently limited by procedural com- plexity and the limits of health screening. This research will redefine sub-components of the quality of service provided by a general health examination center during the examination process based on the quality factors of medical services proposed in previous research.
2. Methods 2.1 Study Design
This is a qualitative analysis performed through in-depth interviews of providers and customers of medical services to identify sub- components of the service quality provided by general health examination centers.
2.2 Sample
Interviewees consisted of medical service providers and customers. The providers were medical and administrative staff at B center, a health examination center in Seoul. Snow- ball sampling was used. A total of 10 personnel were interviewed : one specialist each in the internal medicine, radiology, digestive medi- cine, and family medicine departments, four nurses, one clinic pathologist, and one tele- phone administration staff person. Customers of these medical services who visited the health examination center participated in interviews.
Individual in-depth interviews were conducted with nine customers who received health examination services at A tertiary hospital.
2.3 Data Collection Procedure
Individual interview data of providers were gathered between September 2~24, 2015 while customer data was collected between Septem- ber 15 and October 2, 2015. The length of
individual interviews did not exceed 30 minu- tes and ambiguous responses were reassessed in telephone interviews to clarify any ambi- guities. Efforts were made to meet the require- ment for sufficient data reaching data satura- tion when there was no new additional data.
Open questionnaires for interviews were created with reference to the research of Yoo [2015] and Park [2015], and two copies were prepared for each medical service provider and customer. At the beginning of the interview, respondent demographic data were gathered through casual questions. Respondents were led to talk freely about the health examination services they had experienced as the inter- views proceeded. Then, using a semi-struc- tured questionnaire, questions were asked about the service quality factors that customers con- sider when evaluating their experience with health screening services. In the questionnaire for medical service providers, in-depth inter- views were conducted regarding inconveniences for examinees observed during health exami- nation and the demand for improved service.
In the questionnaire for customers, interviews focused more on the inconvenience, discomfort, and improvement requirements that arise during the process from reservation to exami- nation and result confirmation.
2.4 Data Analysis
In this research, data were primarily ana-
lyzed using the affinity diagram [Kawakita,
1960], which organizes a large number of ideas
and data based on their mutual relationships
to define or conceptualize services [Korea
Institute of Design Promotion, 2012]. After pri-
mary analysis with the affinity diagram, re-
sulting data were sorted and analyzed secon-
darily according to the criteria suggested by
Donabedian [1980, 1983, 1987, 1990] : physical,
human, procedural, and support factors.
Then, 52 sub-components were validated by seven experts, including three specialists with five years of experience or more currently working in health examination centers, three designers who have worked in promotion or design departments in general hospitals for 10 years or more, and a president of a design institute. The session was conducted for about 90 minutes in a small seminar room and recorded after obtaining consent from the panel. Handouts containing 52 items deduced from the preliminary survey were distributed, and the panel was asked to review components of service quality including the appropria- teness of name and classification. Determina- tions were made to ‘adopt,’ ‘revise,’ ‘discard,’
or ‘add’ components of the review.
2.5 Ethical Consideration
This research had the following measures in place to protect the rights of interviewees.
First, all study participants provided informed consent. The identity of researchers was dis- closed, and the interviewees were notified prior to the interview that a smartphone would be used to record the interview. In addition, it was explained that the recorded content would never be used for a purpose other than the current research project. The anonymity of interviewees was guaranteed, and consent was obtained in writing from respondents before proceeding with the research.
3. Results
3.1 Subject Characteristics
Interview subjects were divided into provi- ders and customers of health screening ser- vices. The interviewed providers of health screening service consisted of three males and seven females aged 28~45, including doctors,
nurses, and administrative staff. The inter- viewed customers of health screening service were composed of five males and four females aged 20~51 including office workers, busi- nessmen, students, and housewives. Refer to
<Table 1> and <Table 2> for more details about subjects.
Gender Age Occupation Work Experience
(yrs) Education Male 41 gastroenterology
specialist 7 Doctor
Female 45 gastroenterology
specialist 4 Doctor
Male 37 radiology
specialist 4 Master
Female 38 family medicine
specialist 4 Bachelor
Female 28 endoscopy room
nurse 6 Bachelor
Male 32 endoscopy room
nurse 3 Community
College Graduate Female 31 reception desk
nurse 6 Community
College Graduate Female 29 radiology room
nurse 2 Community
College Graduate Female 29 medical
technologist for
blood collection 3 Community College Graduate Female 39 administrative
staff receiving
phone calls 4 Bachelor
<Table 1> Demographic Information of the Providers of Health Screening Services Interviewed
Gender Age Occupation Education Male 41 company worker Master
Female 32 housewife Bachelor
Female 51 self-employed Master Male 33 company worker Bachelor Male 40 company worker Bachelor Female 20 student Community College
Graduate
Female 37 housewife Bachelor
Male 29 company worker Community College Graduate Male 35 company worker Master
<Table 2> Demographic Information of the Customers of Health Screening Services Interviewed
Division No Components of Health Screening Service
Physical Factors
1 monitors displaying waiting information 2 short distance between examinations 3 all examinations on the same floor
4 separation of examination areas for males/females 5 gallery zone in the corridor
6 proximity to recovery room and bathroom 7 secondary recovery room
8 shower stalls in the dressing room 9 cleanliness of the bed
10 check endoscope instrument disinfection room 11 tv, magazines, and massager in waiting areas
12 name tags for medical staff with titles (internal medicine specialist 000) 13 patient gown easy to put on and remove
14 baskets for personal belongings (cellphones, glasses) 15 bracelet type RFID navigator to view the examination status 16 large information map
17 numbered signs (e.g. blood collection room 3) 18 result sheet with major results highlighted 19 readability of endoscopy consent form
20 video of examination guide provided in waiting area 21 device information posters
22 cellphone chargers in waiting area 23 recognition of the health screening center
Human Factors
24 adequate explanation of examination items when making a reservation on the phone 25 personal guide accompanying throughout the screening process
26 medical staff with ability and competence 27 kindness of medical staff
28 advance notice of the occurrence of pain by examination
29 brief explanation of result after examination (endoscopy/ ultrasound) 30 explain which part being examined during ultrasound
31 warm ultrasound gels
32 advance notice of expected waiting time 33 recognition/celebrity of medical staff
<Table 3> Basic Materials for the Components of Health Screening Service Quality Collected from the Interviews
3.2 Results of Interviews
After items about health screening ser- vices were extracted from the data collected from respondents, similar or repetitive items were eliminated and the components of health screening services were identified. These were classified into eight categories, including pre- paration for health examination, examination
environment, examination in general, endo- scopy, ultrasound, waiting environment, out- come management, and complaint manage- ment, with a total of 59 sub-components.
Based on the four components suggested
by Donabedian [1980, 1983, 1987, 1990], ser-
vice components were classified as four cate-
gories with 52 sub-components after secon-
dary classification <Table 3>.
Division No Components of Health Screening Service
Procedural Factors
34 easy reservation (securing desired reservation time) 35 reservation confirmation texts
36 check medication/medical history
37 additional examination after consulting preliminary examination doctor
38 emergency treatment available in the occurrence of complications (bleeding, perforation) 39 call guardians in emergency
40 female gynecologist in ob/gyn
41 sleep quality management during sleep endoscopy preventing the patients from being awake 42 adequate rest after sleep endoscopy
43 appropriateness of waiting time 44 quick confirmation of the result 45 easy connection to outpatient treatment
Support Factors
46 system reaffirming medical history to the medical staff at the time of examination 47 parking support service (valet service)
48 redistribution system of waiting customers to ease congestion 49 establishing database of the medical history
50 suggestion of tests based on the database
51 personalized management: programs for those at risk for chronic disease (smoking cessation/ diet) 52 dedicated customer response team
<Table 3> Basic Materials for the Components of Health Screening Service Quality Collected from the Interviews(Continue)
3.3 Result of Validation by Expert Panel The 52 sub-components were validated by seven experts in medical service areas. <Table 4> provides detailed information.
3.3.1 Physical Factors
For physical factors, 16 items were adopted, six were revised or integrated, and four were discarded. The revised or integrated factors were as follows: three items for ‘short distance between examinations,’ ‘all examinations on the same floor’, and ‘proximity to recovery room and bathroom’ were revised and inte- grated into ‘short distance between examina- tions and convenience of grasping the struc- ture.’ In addition, ‘cleanliness of the bed’ was expanded to ‘cleanliness of the facilities (space, gown, dress for the medical staff, etc.)’. ‘Large
information map’ and ‘numbered signs’ were revised and integrated into ‘numbered signs for check-up rooms and large information map on the wall (e.g. Blood Collection Room 3).’
Those factors discarded by the expert vali- dation process were ‘gallery zone in the corri- dor’, ‘shower stalls in the dressing room’,
‘device information posters’, and ‘examination center recognition’. ‘Gallery zone in the corri- dor’ and ‘shower stalls in the dressing room’
were discarded because they are beyond the
scope of universal service elements and ‘de-
vice information posters’ was discarded as it
was not considered to be a health examination
service. ‘Examination center recognition’ was
eliminated because recognition cannot be
regarded as a service factor, as examination
centers include a range of institutions from
private clinics to general hospitals.
Division Description
Physical Factors
Space
1 Efficiency of examination space organization and moving lines 2 separation of examination areas for males/females
3 Provision of amenities in waiting areas (TV, magazines, massager, etc.) 4 Provision of secondary recovery room
Convenient Facilities
5 Provision of baskets for personal belongings (cellphone, glasses) 6 Provision of cellphone chargers in waiting areas
7 Easiness of putting on and removing patient gown Safety
Facilities
8 Check disinfection of endoscopy devices
9 cleanliness of the facilities (space, gown, dress for the medical staff, etc.)
Information Facilities
10 Can the examination status be referred to instantly (using portable electronic device, etc.)?
11 Is waiting information visually provided? (displayed on the monitor, etc.)
12 Is the sings for check-up rooms and information map on the wall (e.g. Blood CollectionRoom 3) readable?
13 Are major results in the result sheet highlighted?
14 Is the endoscopy consent form readable?
15 Is the video of examination guide provided (in waiting areas or endoscopy room)?
16 Is the position specified in the name tag (internal medicine specialist 000)?
Human Factors
1 Is examination information adequately explained (when making reservation on the phone)?
2 competence and recognition of medical staff 3 kindness of medical staff
4 Is advance notice (of waiting time/occurrence of pain) provided?
5 Is explanation provided during ultrasound (which part being examined)
6 Is brief explanation of the result after examination (endoscopy/ultrasound) provided?
7 Is warm ultrasound gel applied?
Procedural Factors
1 easy and precise reservation (securing desired reservation time and sending reservationconfirmation texts) 2 Is medication/ medical history checked?
3 Is additional examination after consulting preliminary examination doctor available?
4 Is emergency treatment and response available in the occurrence of complications(bleeding, perforation, shock, etc.)?
5 Is female gynecologist available in ob/gyn?
6 Is the quality of sleep endoscopy (maintaining sleep during endoscopy and adequaterest after the procedure) being managed?
7 Is hygiene thoroughly managed to prevent infection?
8 Is waiting time for examination appropriate?
9 Is it possible to check the result quickly?
10 Is it easy to connect to outpatient treatment?
Support Factors
1 Is the medical examination history database established to notify medical staff and suggestrequired tests?
2 Is parking support (valet service) available?
3 Is redistribution system of waiting customers to ease congestion available?
4 Is porridge/ meal provided after examination?
5 Is personalized management programs (for smoking cessation, diet, exercise, etc.)available based on the result?
6 Is there a dedicated customer response team?
<Table 4> Finalized Components of Comprehensive Health Screening Service Quality
